=====================================================
General NPI Number Information
=====================================================
NPI Number | 1679340996
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANE E KITTLESON OTR
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2023
-----------------------------------------------------
Last Update Date | 12/06/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 310 W 98TH ST APT 2B
-----------------------------------------------------
City | NEW YORK
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10025-5531
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-578-4953
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 249 E BROADWAY BLVD APT 410
-----------------------------------------------------
City | JEFFERSON CITY
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37760-2863
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 225X00000X
-----------------------------------------------------
Taxonomy Name | Occupational Therapist
-----------------------------------------------------
License Number | 026695
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------